Associated ileocaecal location is a marker for greater severity of low rectal endometriosis.

OBJECTIVE: To determine whether ileocaecal endometriosis (ICE) is a marker for low rectal endometriosis (LRE) severity. DESIGN: Retrospective cohort study. SETTING: France. POPULATION AND SAMPLE: Analysis of 375 colorectal resections performed in women undergoing complete surgery for LRE from January 1995 to December 2015 in a university centre for endometriosis. METHODS: Univariate and multivariate analysis of anatomical, postoperative clinical, and long-term outcomes according to presence of ICE. MAIN OUTCOMES AND MEASURES: Mean number and type of deep infiltrating endometriosis (DIE) lesions, the existence of an associated endometrioma, and mean total American Society for Reproductive Medicine (ASRM) score. RESULTS: The prevalence of ICE was 25.6%. Primary end-point data showed that women with ICE had a significantly higher adjusted number of DIE lesions (OR = 1.43, 95% CI 1.02-3.03; P = 0.048), higher prevalence of endometriomas (OR = 1.91, 95% CI 1.04-3.51; P = 0.044), more associated DIE sigmoid lesions (OR = 2.12, 95% CI 1.07-3.91; P = 0.025), and a higher mean total ASRM score (OR = 2.07, 95% CI 1.12-4.14; P = 0.025). Women with ICE resected during the surgical procedure for LRE did not have more adverse postoperative clinical outcomes than ICE-negative patients. CONCLUSION: Ileocaecal endometriosis was significantly associated with greater LRE severity. In a complete surgical resection strategy, combining resection of ICE and LRE did not appear to increase postoperative rates of complications, morbidity or recurrence, nor did it seem to impair long-term clinical outcomes. TWEETABLE ABSTRACT: In women with low rectal endometriosis, 25% have an associated ileocaecal location that is a marker for severity.

[The use of the Debriefing Assessment for Simulation in Healthcare (DASH) in a simulation-based team learning program for newborn resuscitation in the delivery room]. / Intérêt de la grille DASH pour l'évaluation de la qualité des débriefings : étude au cours d'un programme de simulation autour de la réanimation du nouveau-né en salle de naissance.

OBJECTIVE: To evaluate the contribution of the Debriefing Assessment for Simulation in Healthcare (DASH, Centre for Medical Simulation, Harvard) in a high-fidelity simulation in situ program used for newborn resuscitation training. METHODS: The DASH was scored by trainees and instructors at the end of the session. The instructors' feedback and opinions were collected. RESULTS: The study included 16 training sessions (ten maternity units) with 156 trainees and ten instructors (45 DASH). The mean DASH score was rated at 6.6/7 by the learners and 5.4/7 by the instructors. For each element, the instructors scored the DASH lower than the learners (P<0.001). For each session, the instructors' DASH scores were lower than the learners' score (P<0.001). The instructors' DASH scores progressed during the first three sessions of the study. The instructors evaluated the DASH's usefulness at 3.6/7 in self-evaluation and at 6.3/7 if used collectively. CONCLUSION: The trainees evaluated the debriefing with high-level DASH scores, thus validating the educational aim of the program. In contrast, the instructors' DASH scores were lower and heterogeneous. Debriefing high-fidelity simulations remains a complex exercise. The use of the DASH can be a helpful measure for instructors in regard of their own practice. Its main advantage could be in providing a validated tool that will allow a "debriefing of debriefing".

Abdominal emergencies during pregnancy.

Abdominal emergencies during pregnancy (excluding obstetrical emergencies) occur in one out of 500-700 pregnancies and may involve gastrointestinal, gynecologic, urologic, vascular and traumatic etiologies; surgery is necessary in 0.2-2% of cases. Since these emergencies are relatively rare, patients should be referred to specialized centers where surgical, obstetrical and neonatal cares are available, particularly because surgical intervention increases the risk of premature labor. Clinical presentations may be atypical and misleading because of pregnancy-associated anatomical and physiologic alterations, which often result in diagnostic uncertainty and therapeutic delay with increased risks of maternal and infant morbidity. The most common abdominal emergencies are acute appendicitis (best treated by laparoscopic appendectomy), acute calculous cholecystitis (best treated by laparoscopic cholecystectomy from the first trimester through the early part of the third trimester) and intestinal obstruction (where medical treatment is the first-line approach, just as in the non-pregnant patient). Acute pancreatitis is rare, usually resulting from trans-ampullary passage of gallstones; it usually resolves with medical treatment but an elevated risk of recurrent episodes justifies laparoscopic cholecystectomy in the 2nd trimester and endoscopic sphincterotomy in the 3rd trimester. The aim of the present work is to review pregnancy-induced anatomical and physiological modifications, to describe the main abdominal emergencies during pregnancy, their specific features and their diagnostic and therapeutic management.

Role of the CXCL12-CXCR4 axis in the development of deep rectal endometriosis.

Immunological and angiogenetic factors enhance the implantation of endometrial cells in the peritoneal cavity. The aim of this work was to determine the role of the CXCL12-CXCR4 axis in the attraction and the peritoneal implantation of endometriotic stromal cells in deep infiltrating endometriosis (DIE). Biopsies of DIE nodules were obtained from 14 patients undergoing surgical treatment for DIE with low rectal involvement and from 12 patients without macroscopic endometriosis undergoing laparoscopy. CXCR4 expression was evaluated by Western blot analysis and flow cytometry in eutopic endometrial cells and DIE stromal cells in primary cultures derived from the biopsies. CXCL12-induced migration of DIE eutopic endometrial stromal cells was evaluated by transwell migration. CXCL12 was assayed in peritoneal fluids by ELISA. CXCR4 expression was higher in eutopic endometrial stromal cells than in control endometrial cells (p<0.05) and in DIE stromal cells (p<0.05). Eutopic endometrial stromal cells were more attracted by CXCL12 than control cells (p<0.01). CXCL12 was higher in DIE peritoneal fluids than in controls (p<0.05). CXCR4 was down-regulated in deep infiltrating endometriotic stromal cells. The CXCL12-CXCR4 axis plays a role in the attraction of eutopic endometrial cells into the peritoneal cavity, and the down-regulation of CXCR4 in resident endometriotic cells could cause their arrest in situ.

Durable resistance to stripe rust is due to three specific resistance genes in French bread wheat cultivar Apache.

Quantitative resistance is postulated to be more durable than qualitative (R-gene mediated) resistance, which is usually quickly overcome by the pathogen population. Despite its wide use for nearly 10 years in France, the French bread wheat cultivar Apache remains resistant to stripe rust. Here, we investigated the genetic architecture of cv. Apache resistance to examine whether its durability could be explained by quantitative characteristics. We identified quantitative trait loci (QTL) by composite interval mapping of disease progress data recorded throughout 4 years of field assays. These assays included inoculation with three different pathotypes on a segregating population originating from a cross between cv. Apache and cv. Taldor, a French cultivar susceptible to stripe rust. Three QTLs derived from Apache, QYr.inra-2AS, QYr.inra-2BL and QYr.inra-4B, were detected. Each of these QTLs contributed between approximately 15 and 69 % of the phenotypic variance and corresponds to a race-specific resistance gene. We showed that QYr.inra-2AS and QYr.inra-2BS map to the positions of Yr17 and Yr7, respectively, whereas QYr.inra-4B corresponds to an adult plant resistance gene. Our results demonstrate that a combination of two or more race-specific resistance genes can confer durable resistance provided that it is properly managed at a continental level. Race-specific resistance genes should not be removed from breeding programs provided that they are properly managed.

The organotelluride catalyst LAB027 prevents colon cancer growth in the mice.

Organotellurides are newly described redox-catalyst molecules with original pro-oxidative properties. We have investigated the in vitro and in vivo antitumoral effects of the organotelluride catalyst LAB027 in a mouse model of colon cancer and determined its profile of toxicity in vivo. LAB027 induced an overproduction of H(2)O(2) by both human HT29 and murine CT26 colon cancer cell lines in vitro. This oxidative stress was associated with a decrease in proliferation and survival rates of the two cell lines. LAB027 triggered a caspase-independent, ROS-mediated cell death by necrosis associated with mitochondrial damages and autophagy. LAB027 also synergized with the cytotoxic drug oxaliplatin to augment its cytostatic and cytotoxic effects on colon cancer cell lines but not on normal fibroblasts. The opposite effects of LAB027 on tumor and on non-transformed cells were linked to differences in the modulation of reduced glutathione metabolism between the two types of cells. In mice grafted with CT26 tumor cells, LAB027 alone decreased tumor growth compared with untreated mice, and synergized with oxaliplatin to further decrease tumor development compared with mice treated with oxaliplatin alone. LAB027 an organotelluride catalyst compound synergized with oxaliplatin to prevent both in vitro and in vivo colon cancer cell proliferation while decreasing the in vivo toxicity of oxaliplatin. No in vivo adverse effect of LAB027 was observed in this model.

Risk factors for conversion and complications after unilateral laparoscopic adrenalectomy.

BACKGROUND: Laparoscopic adrenalectomy (LA) is the procedure of choice for surgical management of most benign adrenal tumours, with a reported overall complication rate around 10 per cent. The aim of this study was to determine predictive factors for postoperative complications and conversion to open surgery after unilateral LA. METHODS: From 1994 to 2009, consecutive patients undergoing unilateral LA by the lateral transabdominal approach were analysed from a prospectively maintained database. A mass larger than 12 cm in diameter and suspected primary adrenal carcinoma were considered contraindications to LA. Predictive factors for postoperative complications and conversion to open surgery were analysed. RESULTS: Some 462 patients were analysed. There were no postoperative deaths. Postoperative complications occurred in 53 patients (11·5 per cent), medical complications in 28, and surgical complications in 33 patients. Six patients underwent reoperation for complications. Multivariable logistic regression analysis showed that conversion to open surgery (odds ratio (OR) 6·20, 95 per cent confidence interval 2·08 to 18·53; P = 0·001) and left-sided tumour (OR 1·89, 1·02 to 3·52; P = 0·044) were independent predictive factors for overall complications. Conversion to open surgery was the only independent predictive factor for medical complications (OR 12·88, 4·21 to 39·41; P = 0·001), and left-sided LA was the only predictive factor for surgical complications (OR 2·22, 1·01 to 4·89; P = 0·047). No factor was predictive of conversion to open surgery. CONCLUSION: In this single-institution study, conversion to open surgery and left-sided tumours were independent predictive factors for overall complications, but none of the variables analysed was predictive of conversion.

Digestive tract measurements and histological adaptation in broiler lines divergently selected for digestive efficiency.

Two lines of broilers divergently selected for a high (D+) or a low (D-) AME(n) on a wheat-based diet were studied for morphological and histological characteristics of the digestive tract. A total of 630 birds of both lines were slaughtered after a 23-d feeding period. Digestive tract morphology and intestinal histology were investigated on a total of 24 birds to describe the consequences of divergent selection. Birds of the D+ line had 34% heavier gizzards (P < 0.001) and 22% heavier proventriculi than their D- counterparts. In contrast, intestines were 15 to 40% heavier in D- birds, mainly in the jejunum (P < 0.001) and ileum (P < 0.001). Intestinal segments were also longer (between 3 and 6%) in the D- birds. Intestinal villi were larger and longer in D- birds (P < 0.001), mainly in the jejunum (14 to 16%), and crypts were 10 to 15% deeper for the 3 intestinal segments in D- birds (P < 0.001). Muscle layers of the intestine were 17 to 24% thicker (P < 0.001) and goblet cells were 27 to 34% more numerous in the jejunum and ileum of D- birds (P = 0.027). This new characterization of the 2 lines shows that divergent selection based on AME(n) modified the morphology of the proventriculus and gizzard, suggesting greater activity of this compartment in D+ than in D- birds. Intestinal adaptation revealed by visceral organ weight and length and histological modifications in D- birds can be viewed as an attempt to compensate for the low functionality of the gastric area.

Puccinia striiformis f.sp. tritici presents high diversity and recombination in the over-summering zone of Gansu, China.

Puccinia striiformis f.sp. tritici (PST), a basidiomycota responsible for wheat yellow rust, has a strict clonal behavior and a low genetic diversity in European and Australian populations. On the other hand high diversity has been reported in Chinese populations. Moreover it is thought that in China yellow rust epidemics start recurrently from the western highlands where over-summering occurs. To compare PST genetic diversity in this area to the one described in France seven AFLP primer combinations were used to analyze a sample of 160 isolates collected in 2001 in five counties of Gansu Province. The AFLP data revealed 40 polymorphic bands, discriminating 139 AFLP genotypes. Linkage disequilibrium and phylogeographic analyses support the hypothesis of a reproductive mode that is not strictly clonal. In this regard Chinese isolates from Gansu strongly contrast with the European studies using the same markers. Genetic diversity of this 1 y sampling in Gansu is found to be seven times higher than the one observed in France over 20 y and exhibits lower linkage disequilibrium. The effective population size of the French sample was estimated to be 1000 times smaller than the Gansu population. These results support the hypothesis of large population size as well as the occurrence of genetic recombination, while the importance of Gansu as a main over-summering area requires assessment through larger scale studies.

Geographic limits of a clonal population of wheat yellow rust in the Mediterranean region.

Most plant pathogens present complex life cycles, in which the clonal reproduction may impede the delimitation of population entities. By studying the genetic structure of the wheat yellow rust caused by Puccinia striiformis f.sp. tritici (PST), we highlighted difficulties impeding population delimitation in highly clonal species. Despite the high dispersal potential of PST, southern France isolates were shown to be divergent from a northwestern European population. A 2-year survey was performed in the Mediterranean region to assess the geographic distribution of southern isolates: 453 isolates collected in 11 countries were genotyped using 15 simple sequence repeat markers. A subsample was analysed for virulence against 23 resistance genes. The dominant strain in the western Mediterranean region was further studied with amplified fragment length polymorphism markers to test for a geographic substructure. Both 'individual'- and 'population'-centred analyses of polymorphism markers revealed two south-specific groups: a predominant group, with a broad variability and a wide distribution in both western and eastern Mediterranean countries, and a minor group in the western Mediterranean. The east-west gradient of genetic diversity suggested gene flow from the Middle East with subsequent founder effects and genetic divergence, and demonstrated the local survival of a western Mediterranean population. The high frequency of the resistance gene Yr8 observed in cultivars from Tunisia and Algeria may contribute to maintain the north/south structure observed in France. In addition to migration and local adaptation, the dynamics of clonal lineage diversification and replacement should be considered to define population entities in strongly clonal species.

Evidence of genetic recombination in wheat yellow rust populations of a Chinese oversummering area.

Wheat yellow rust (Puccinia striiformis f.sp. tritici) (PST) has been described as a strongly clonal species in both European and Australian populations, with very limited molecular diversity but rapidly evolving virulences. Contrastingly, marked genetic diversity has been reported in Chinese PST populations. To test whether such variability could originate from oversummering areas, we assessed the diversity of virulence and molecular markers (AFLP and SSR) using 412 PST isolates from the highlands of Tianshui county in Gansu province. Very marked phenotypic and genotypic diversity (38% and 89%, respectively) was found. No genetic structure dependent on the sites sampled (Fst=0.004) or altitude distribution (Fst=0.0098) was detected, indicating important gene flow at the county scale. This study also revealed genetic recombination between molecular markers and thus strongly suggests the existence of a sexual or parasexual cycle in PST in Tianshui county. The observations of higher rates of sexual spore production in genotypes originating from Tianshui are the very first elements suggestive of the existence of a sexual cycle in this species.

Co-composting rice hulls and/or sawdust with poultry manure in NE Argentina.

Rice hulls and sawdust are two common C-rich wastes derived from rice and timber agro-industries in subtropical NE Argentina. An alternative to the current management of these wastes (from bedding to uncontrolled burning) is composting. However, given their C-rich nature and high C/N ratio, adequate composting requires mixing with a N-rich waste, such as poultry manure. The effect of different proportions of poultry manure, rice hulls and/or sawdust on composting efficiency and final compost quality was studied. Five piles were prepared with a 2:1 and 1:1 ratio of sawdust or rice hulls to poultry manure, and 1:1:1 of all three materials (V/V). Different indicators of compost stability and quality were measured. Thermophilic phase was shorter for piles with rice hulls than for piles with sawdust (60 days vs. 105 days). Time required for stability was similar for both C-rich wastes (about 180 days). Characteristics of final composts were: pH 5.8-7.2, electrical conductivity 2.5-3.3 mS/cm, organic C 20-26%, total N 2.2-2.9%, lignin 19-22%, total Ca 18-24 g/kg, and extractable P 6-8 g/kg, the latter representing 60% of total P. Nitrogen conservation was high in all piles, especially in the one containing both C-rich wastes. Piles with sawdust were characterized by high total and available N, while piles with only rice hulls had higher Si, K and pH. Extractable P was higher in 1:1 piles, and organic C in 2:1 piles.

Control of transport-barrier relaxations by resonant magnetic perturbations.

Transport-barrier relaxation oscillations in the presence of resonant magnetic perturbations are investigated using three-dimensional global fluid turbulence simulations from first principles at the edge of a tokamak. It is shown that resonant magnetic perturbations have a stabilizing effect on these relaxation oscillations and that this effect is due mainly to a modification of the pressure profile linked to the presence of both residual magnetic island chains and a stochastic layer.

[Surgical management of primary esophageal motility disorders]. / Traitement chirurgical des troubles moteurs de l'oesophage.

Primary esophageal motility disorders are rare, the most common diagnoses being achalasia and diffuse esophageal spasm. Treatment aims to alleviate symptoms and may be medical, endoscopic, or surgical. Achalasia is most commonly treated by pneumatic dilatation or by laparoscopic Heller cardiomyotomy. Pneumatic dilatation is effective in 60-80% of cases, but functional results deteriorate over time. Surgical treatment is indicated when endoscopic dilatation is contraindicated or has failed. Functional results after cardiomyotomy are satisfactory in 90% of cases and results appear to be stable over time. The need for an associated antireflux procedure and the type of fundoplication remain controversial. For diffuse esophageal spasm, extended esophageal myotomy has yielded satisfactory functional results, but surgical treatment should be reserved for selected patients with severe symptoms.

The effects of fructo-oligosaccharides or whole wheat on the performance and digestive tract of broiler chickens.

1. The objective of this experiment was to study two feeding methods, which could potentially act on the gut microflora, the structure and/or the function of the digestive tract and thereby improve the performance of broilers. 2. Four dietary treatments were studied: a negative control (wheat based) with no additives (C), a positive control with 0.01 g/kg avilamycin (AV), a treatment with 0.6 g/kg fructo-oligosaccharides (FOS) and a treatment with the same composition as treatment C but in which a part or all (400 g/kg) of the wheat was given as whole wheat and a concentrate supplement (WW). The measurements were: the performance from 0 to 6 weeks, the bacterial counts at 3 and 6 weeks, the digestive tract morphology and the activity of some intestinal enzymes at 3 weeks. 3. The birds given AV had better daily live weight gain (DLWG) and feed conversion ratio (FCR) compared to treatment C. The birds given FOS had a lower feed intake and a lower DLWG than the birds on treatment C but their FCR was significantly improved. WW resulted in a numerically lower feed intake and a significantly lower DLWG than treatment C. With AV, the number of aerobic mesophilic bacteria in the caeca was reduced at 3 weeks. With WW, gizzard and pancreas weights were greater and the surfaces of the ileal crypts were larger. An increased activity of leucine aminopeptidase (LAP) in the duodenum was found for treatments AV, FOS and WW. 4. In conclusion, in this study, treatments WW and FOS reduced DLWG, which may have been due to a lower feed intake during the whole period. With WW, the FCR was not affected, maybe because of both positive and negative effects on digestive tract (higher gizzard and pancreas development and LAP activity; larger crypts). However, FOS improved FCR, which may be partly explained by the higher LAP activity.

Functional results after extended myotomy for diffuse oesophageal spasm.

BACKGROUND: The role of surgery in the management of patients with diffuse oesophageal spasm (DOS) remains controversial. The aim of this study was to assess functional results after extended myotomy for DOS. METHODS: This prospective study evaluated 20 patients who had extended myotomy (14 cm on the oesophagus and 2 cm below the oesophagogastric junction) with anterior fundoplication via a laparotomy for severe DOS. Median follow-up was 50 (range 6-84) months. Functional data were assessed by means of dysphagia (range 0-3), chest pain (range 0-3) and overall clinical (range 0-12, including dysphagia, chest pain, regurgitation, gastro-oesophageal reflux) scores. RESULTS: All patients had severe DOS. The median preoperative overall clinical score was 6 (range 3-8) with a dysphagia score of at least 2. Median postoperative functional scores were significantly lower than preoperative values (overall clinical score 1 versus 6, dysphagia score 0 versus 3, chest pain score 0 versus 2). At final follow-up, good or excellent results were obtained for overall clinical score in 16 patients, for dysphagia score in 18 and for chest pain score in all 20 patients. Postoperative gastro-oesophageal reflux was noted in two of the 20 patients. CONCLUSION: Extended myotomy with anterior fundoplication is an effective treatment for severe DOS. Medium-term postoperative functional results were excellent, especially in terms of dysphagia and chest pain.

[Surgical treatment of rectal endometriosis]. / Traitement chirurgical de l'endométriose rectale.

Intestinal endometriosis accounts for 8-12% of all endometriosis and rectal involvement is most often encountered in the context of deep pelvic infiltration. Intestinal symptoms, often nonspecific, are most typically seen as painful defecation or constipation worsening in the premenstrual period associated with pelvic pain, dysmenorrheal, dyspareunia, and infertility. Physical examination should include a pelvic exam under anesthesia. Endorectal ultrasound best evaluates rectal muscle invasion, while pelvic MRI and CT will evaluate the full extent of pelvic involvement and other GI sites of implantation. Only radical extirpative surgery of all intestinal, urologic, deep pelvic, and adnexal sites of endometriosis will permit relief of pain, prevent recurrence, and hopefully preserve fertility. In view of the frequency of extra-intestinal sites of involvement and technical difficulties augmented by previous surgical interventions, open laparotomy remains the preferred approach. A laparascopic approach would be reserved only for well-selected patients presenting with isolated colorectal involvement.